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While we can get carried away and draw too much meaning from certain milestones, early observations of speech and language can help identify a speech disorder or a stutter — and lead to early intervention that can make a huge difference in our kids’ lives.

Speaking is a tough thing to learn. It’s a complex fine-motor skill that involves mapping abstract linguistic structures to dynamic sequences of muscle movements — and quickly. So if your child is having trouble with it, keep in mind that it is not unlike learning to play the piano or to write for the first time.

But if your child is very late with those first words, compared to other kids of the same age, or is missing or misarticulating certain sounds when they speak, you should seek out a speech-language pathologist. We are specialists in dealing with speech and language problems and can use a combination of techniques — from breathing drills and articulation exercises to simply allowing them to speak at a slower pace.

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It’s important to spot the signs early. For example, young children might have a speech disorder if they have trouble combining sounds, grope for words or sounds, leave out parts of words, add sounds in incorrect places, or substitute hard-to-pronounce sounds for easier but incorrect ones.

Also watch for stuttering. Although making errors in speech is quite typical for kids — especially when they’re really excited about what they’re saying — it can sometimes lead to a lifelong problem. With stuttering, a good thing to look out for is whether the child is repeating a complete word (which is usually fine) or if they are repeating parts of words. That’s what we call “part-word disfluency.”

If you notice these part-word disfluencies, which might be accompanied by some trouble pronouncing words, it’s a good idea to find professional help. While many kids will outgrow their stuttering, a speech-language pathologist can significantly improve the speech fluency for those at risk of permanent stuttering.

While some of these behaviours can be part of a normal development — again, speaking is tough — they might also be early signs of an underlying speech-sound disorder. And if that’s the case, it’s important to find appropriate treatment, as it won’t go away on its own. Speech issues can lead to psychosocial problems like anxiety and affect literacy development and overall performance at school.

In our Oral Dynamics Lab at the University of Toronto, we study the mechanisms involved in both regular and disordered speech, and we do research on various aspects of speech science and oral motor control. In one recent study, we found that children with a severe speech-sound disorder needed a high-intensity treatment — in this case two speech-language pathology sessions per week, instead of one — to see significant results.

Families play an important role in therapy. There are things you can do to help a child who’s dealing with a speech disorder — and also things you should avoid. For example, speaking quickly and trying to elevate your language above what your child is ready for won’t help, and will likely lead to more frustration and anxiety. Instead, parents and family members should slow down their speech, try to use simple words and give each sibling a turn to speak, even when it may take a bit longer for some than for others.

Even if it seems to come easily, speaking is a complex skill to master. For all motor tasks — like playing tennis, for example — some people will just naturally be more skilful than others. That’s also the case with speaking, according to our research. But unlike with tennis, which you could decide to simply avoid playing, you can’t just decide not to speak!

If your child is struggling — it’s important to get help.

Dr. Pascal van Lieshout is a professor and the chair of the Department of Speech-Language Pathology at the University of Toronto. He is also the founder of the Oral Dynamics Lab (ODL). Dr. Aravind Namasivayam is a researcher at ODL and lecturer at the Department of Speech-Language Pathology. Doctors’ Notes is a weekly column by members of the U of T Faculty of Medicine. Email doctorsnotes@thestar.ca .

Common Speech Disorders

Speech-sound disorders: An umbrella term relating to difficulties with articulation and use of proper speech sounds, usually diagnosed in preschool and school-age children. An estimated 2-25 per cent of children aged 5-7 have a speech-sound disorder.

Phonological delay: A speech-sound disorder in which speakers leave out parts of words or add sounds in incorrect places.

Motor-based disorders: Speech-sound disorders in which people have trouble making the necessary motor movements for sounds. Examples include apraxia and dysarthria.

Structurally based disorders: These occur when pronunciation is affected by a structural issue, such as with cleft palate.

Sensory-based disorders: Disorders such as hearing loss, when speech is affected due to a sensory deficit.

Childhood apraxia of speech (CAS): This is a rare disorder in which children have difficulty planning and producing speech movements, resulting in errors in speech sound production and rhythm. It is estimated that 3-5 per cent of children with speech-sound disorders have this.

Stuttering: Stuttering is defined as a disruption in the flow of speech, characterized by repetitions in sounds, syllables, words, and phrases. Developmental stuttering has no known cause and is possibly related to limited speech motor skills. About 5 per cent of people will stutter during some part of their lives.

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